Endoscopic Retrograde Cholangiopancreatograp... Health Article

Definition

Endoscopic retrograde cholangiopancreatography (ERCP) is an imaging technique used to diagnose diseases of the pancreas, liver, gallbladder, and bile ducts. It combines endoscopy and x-ray imaging.

Purpose

ERCP is used in the management of diseases that affect the gastrointestinal tract, specifically the pancreas, liver, gall bladder, and bile ducts. The pancreas is an organ that secretes pancreatic juice into the upper part of the intestine. Pancreatic juice is composed of specialized proteins that help to digest fats, proteins, and carbohydrates. Bile is a substance that helps to digest fats; it is produced by the liver, secreted through the bile ducts, and stored in the gallbladder. Bile is released into the small intestine after a person has eaten a meal containing fat.

A doctor may recommend ERCP if a patient is experiencing abdominal pain of unknown origin, weight loss, or jaundice. These may be symptoms of biliary disease. For instance, gallstones that form in the gallbladder or bile ducts may become stuck there, causing cramping or dull pain in the upper right area of the abdomen, fever, and/or jaundice. Other causes of biliary obstruction include tumors, injury from gallbladder surgery, or inflammation. The bile ducts may also become narrowed (called a biliary stricture) as a result of cancer, blunt trauma to the abdomen, pancreatitis (inflammation of the pancreas), or primary biliary cirrhosis (PBC). PBC may be caused by a condition called primary sclerosing cholangitis, an inflammation of the bile ducts that may cause pain, jaundice, itching, or other symptoms. These symptoms may also be experienced by a patient with cholangitis, or with infection of the bile ducts caused by bacteria or parasites.

ERCP can also be used to diagnose a number of pancreatic disorders. Pancreatitis is an inflammation of the pancreas, caused by chronic alcohol abuse, injury, obstruction of the pancreatic ducts (e.g., by gallstones), or other factors. The condition may be either acute (having a severe but short course) or chronic (persistent). Symptoms of pancreatitis

creatitis include abdominal pain, weight loss, nausea, and vomiting. ERCP may be used to diagnose cancer of the pancreas; pancreatic pseudocysts (collections of pancreatic fluid); or strictures of the pancreatic ducts. Certain congenital disorders may also be identified by ERCP, such as pancreas divisum, a condition in which parts of the pancreas fail to fuse together during fetal development.

Demographics

Diseases of the pancreas and biliary tract affect millions of Americans each year. According to the National Health and Nutrition Survey, gallbladder disease affects approximately 6.3 million men and 14.2 million women in the United States between the ages of 24 and 74. Approximately one million new cases of gallstones are diagnosed each year. The incidence of gallstones is higher among women; adults over the age of 40; and people who are overweight. Primary sclerosing cholangitis occurs at a rate of two to seven cases per 100,000 persons. The rate of gallbladder cancer is approximately 2.5 out of 100,000 persons. In addition, approximately 87,000 cases of pancreatitis and 30,000 cases of pancreatic cancer are diagnosed each year in the United States.

Description

ERCP is performed with the patient given either a sedative or general anesthesia. The physician then sprays the back of the patient's throat with a local anesthetic. The endoscope (a thin, hollow tube attached to a viewing screen) is then inserted into the mouth. It is threaded down the esophagus, through the stomach, and into the duodenum (upper part of the small intestine) until it reaches the spot where the bile and pancreatic ducts empty into the duodenum. At this point a small tube called a cannula is inserted through the endoscope and used to inject a contrast dye into the ducts. The term "retrograde" in the name of the procedure refers to the backward direction of the dye as it is injected through the ducts. A series of x rays are then taken as the dye moves through the ducts.

If the x rays show that a problem exists, ERCP may be used as a therapeutic tool. Special instruments can be inserted into the endoscope to remove gallstones, take samples of tissue for further examination (e.g., in the case of suspected cancer), or place a special tube called a stent into a duct to relieve an obstruction.